Heart Failure is ’800-Pound Gorilla,’ Experts Say

By Lois M. Collins Deseret Morning News

Patients who have heart failure may have any number of other medical conditions, but physicians often overlook them, blaming symptoms on the weak heart muscle, according to Dr. Dale G. Renlund, medical director of the Heart Failure Program at LDS Hospital.

“That’s common,” he said during Saturday’s Deseret Morning News/ Intermountain Healthcare Hotline on heart failure.

He added facetiously that if someone had a left-ventricular assist device to boost the heart’s pumping action and a broken arm, the latter would be attributed to the former.

Someone who is anemic, for example, may have a bleeding ulcer that needs treatment, and physicians should be looking at that, rather than assuming it’s all heart-failure related, he said.

“Heart failure is the 800-pound gorilla in the room,” he said.

Renlund, nurse practitioner Sally Brush and Charmain Nemelka, a registered nurse, took about 30 calls during the hotline.

Many of the calls were not heart-failure specific but were questions about heart arrhythmias, irregular heartbeats that are a common problem. It’s important to try to get the heart back into a normal rhythm, they were told.

Too much of the thinking about heart failure is old-school, the trio said. One caller told Brush his cardiologist told him that if his dad died young of heart disease, he probably would, too. That’s bad information, “totally ridiculous,” Renlund added.

Exercise is another area where misconception flourishes. Years ago, it was believed exercise was taboo for someone who had heart failure. Patients were told to get bed rest and take it easy and “that mentality still exists, but it’s wrong,” Renlund said.

The fact is that people who have heart failure feel better if they engage in moderate exercise, according to Nemelka, Brush and Renlund, who see the benefits all the time in the patients they treat.

There’s no question quality of life improves with a reasonable amount of exercise. Now researchers are testing in a randomized trial whether exercise also has a positive impact on mortality from the disease.

The only exercises that are bad — and these are gender specific to men — are vacuuming, washing dishes and watching movies that star Hugh Grant or Emma Thompson, Renlund joked.

One of the biggest problems with heart failure is its chronic nature. While people can live longer and better with the disease if they get proper treatment, the fact that it is chronic can be very psychologically debilitating, they said.

“You need to live as normally as you can,” Renlund told a caller.

Brush said people with heart failure often look good and that can create problems, as well, because others don’t understand that they are ill.

Sometimes someone being treated for heart failure improves to the point where the heart is squeezing better, so doctors who don’t specialize in heart failure may say, “Your heart looks quite normal. You don’t need these drugs,” Renlund said.

That’s akin to a doctor measuring the blood sugar of someone who controls glucose levels with insulin and telling him to stop taking the insulin, it’s no longer needed.

With heart failure, if someone stops taking the needed medication that helped the heart muscle function better, the heart typically deteriorates. And when they go back on the medication later, they’re not as responsive and the result is not as good.

Probably the biggest challenge in treating heart failure is communication, they agreed. Patients need to understand why they are using certain treatments and what they can do at home to help manage their heart failure.

That includes a program LDS Hospital staffers call MAWDS: Medication, activity, weight, diet and symptoms.

The hotline tackles a different health topic on the second Saturday of each month.

E-mail: lois@desnews.com